Regulation mechanism of liver regeneration after adult-to adult living-donor liver transplantation

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We have evaluated the regeneration pattern of the small-for-size grafts by performing 12 cases of living-donor liver transplantation, which included six adult-to-adult cases. The graft grows rapidly, reaching 80-90 % of the ideal liver volume within two postoperative months. Analyzes of plasma HGF and TGF varies time-to-time after operation, and patient-to-patient, which made us to conclude that these factors are changing dynamically and seems a little related to the regulation system of the liver regeneration. Blood flow, on the other hand, significantly influenced the regenerative pattern. In cases with hepatic venous stenosis, regeneration speed is markedly reduced, reaching to the 70 % of the other cases. Fatty liver of the donor is another negative factor for regeneration.We tried to build a new artificial liver support system to cover transient liver failure in the course of regeneration of the small-for-size graft. We observed the enough detoxyficcation function of the system.Postoperative hyperbilirubinemia after small-for-size liver transplantation gained another attention. We observed the down regulation of the MRP (multi-drug resistant protein) 2 and the up regulation of the MRP2 by Western-blotting of the liver tissue specimens.